Introduction:
A clear gel-like substance called vitreous humor fills the center of the eye and lies between the retina and the lens near the front of the eye. The vitreous humor contains tiny, intertwined fibers that are connected to the retina from birth and throughout childhood. In young, healthy eyes, the vitreous cortex, a thin shell that surrounds the vitreous is often sealed to the retina.
What Is Vitreomacular Adhesion?
Vitreomacular adhesion affects two parts of the eye, one is vitreous humor, and other one is macula, the most sensitive retinal layer which is responsible for central vision. The vitreous gel slowly liquefies, shrinks, and gradually separates from the retinal surface; this common aging process is known as posterior vitreous detachment. Posterior vitreous detachment commonly occurs in the normal aging process. Sometimes this separation is not complete, and there is still adhesion in the macula, thereby creating a pulling force (traction) resulting in a anatomical damage. This may cause distorted or blurry vision and is called as vitreomacular adhesion, and such a condition is called vitreomacular traction syndrome.
What Are the Signs And Symptoms of Vitreomacular Adhesion?
The symptoms of vitreomacular adhesion include:
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Sharpness of vision is very less.
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Blurry or distorted vision.
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Seems smaller than the actual size (micropsia).
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Experience straight lines become wavy or blank lines (metamorphopsia).
What Are the Risk Factors of Vitreomacular Adhesion?
The risk factors of vitreomacular adhesions include:
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Sex - Vitreomacular adhesion is frequently seen in older women due to the result of declining postmenopausal estrogen levels.
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Myopia - Myopia is also known as nearsightedness. When a person has nearsightedness (myopia), close-up objects are clear but distant objects are blurry. Vitreomacular traction is also seen in myopia patients.
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Age-Related Macular Degeneration - The condition known as age-related macular degeneration (AMD) affects the retina. It occurs when the macula, a part of the retina, is damaged.
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Diabetic Retinopathy - An eye condition caused by diabetes that results in damaged blood vessels.
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Diabetic Macular Edema - It is a condition in which the vein becomes clogged, and blood and liquids leak into the retina. Central vision may be affected if the macula swells up as a result of the fluid.
What Is the Diagnosis of Vitreomacular Adhesion?
The diagnosis of vitreomacular adhesion includes:
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Eye Examinations - Eye professionals will do eye check-ups by dilating the pupils using special eye drops.
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Optical Coherence Tomography - The imaging method known as optical coherence tomography (OCT) employs a low-coherence light to produce two and three-dimensional images with micrometer resolution from an optical scattering medium. Optical coherence tomography scanner provides an automated, segmented representation of the vitreous and macula layers. This image illustrates the degree of vitreomacular traction’s involvement and tension on the macula. This imaging technique is helpful for identifying and treating macular conditions like vitreomacular traction.
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Fluorescein Angiography - A dye is injected into the patient's arm during this treatment and goes to the eye. Then, to check for blockages or leaks, a special camera is used to capture images of the interior of the eye. It is a useful examination that reveals the details of the retina's health. This provides a clear picture of the circulation in real time to the eye professionals. It is also helpful in identifying any swelling, such as cystoid macular edema in the macula caused by vitreomacular traction.
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Ultrasound Examination of the Eye - Ultrasound uses high-energy sound waves to examine the eye by creating echoes as they travel through the internal tissues. A small probe that transmits and receives sound waves is gently put on the eye’s surface after using eye drops to numb the eye. The echoes provide a picture of the eye's interior.
What Treatment Options Are Available for Patients With Vitreomacular Adhesion?
The treatment options available with vitreomacular adhesion are:
1. Wait and Watch - In some cases, wait and watch is the only option, as vitreomacular adhesions may disappear on their own without any treatment. The symptoms must be thoroughly monitored, with daily follow-up and Amid grid tests.
2. Microincisional Vitrectomy Surgery - A vitrectomy is a form of eye surgery used to address a variety of retinal and vitreous diseases. It is the same procedure where the vitreous gel is taken out during surgery and replaced with a different fluid. A tiny, needle-like instrument known as a vitrector is inserted into the eye. The vitreous fluid is aspirated (sucked out) by this device. After that, the surgeon replaces the natural vitreous fluid in the eye with a specific saline solution.
The macula is released from traction when the vitreous is surgically removed, and it eventually reverts to its regular form and structure.
The operation is able to successfully separate the vitreomacular adhesion with 90 % efficacy.
3. Intravitreal Injection Adhesion - Jetrea is a drug that is injected into the eye's vitreous to treat vitreomacular adhesions. The medication works by weakening the protein fibers that hold the vitreous and macula together, which results in the macula and vitreous to safely separating by releasing the traction.
4. Pneumatic Vitreolysis - A tiny gas bubble is injected into the eye when the patient is in a facedown position which is done at a medical facility. In an effort to force the gas bubble to cut the adhesion between the vitreous and the macula. Even when treatment is necessary, the majority of people with vitreomacular traction have acceptable visual acuity in the affected eye.
Conclusion:
Vitreomacular adhesion or traction is an eye condition that involves attachment between the vitreous gel, which fills the eyeball, and the central part of the retina, which lines the back of the eye. It occurs when the vitreous gel separates from the retina except for a persistent central attachment; then, the gel can physically pull the retina and cause swelling or deformation resulting in blurred or distorted vision. The Treatment options include wait and watch (observation), surgery, or injections into the eye. The best course of action is chosen based on the severity of the damage or distortion and the symptoms present. If anyone notices the changes in their vision, consulting an eye specialist and obtaining the treatment at the right time should be a priority.
